Serial high-sensitivity troponin-T and risk of heart failure in individuals with suspected acute coronary syndrome
Year: 2026
Type: article
Study design: Observational Study
Abstract: AIMS: To investigate the association between serial high-sensitivity cardiac troponin-T (hs-TnT) concentrations and subsequent heart failure in individuals presenting with suspected acute coronary syndrome (ACS). METHODS AND RESULTS: Utilizing Danish nationwide registries, we identified individuals without known heart failure who underwent serial hs-TnT assessment for suspected ACS between 2012 and 2019. Individuals were categorized based on the hs-TnT concentration patterns from the first to the second measurement (normal, rising, persistently elevated, or falling), the extent of hs-TnT concentration change (≤20%, >20 to 50%, or > 50%), and quartiles of peak hs-TnT levels (≤9 ng/l, 10-19 ng/l, 20-263 ng/l, and ≥ 264 ng/l). Standardized absolute and relative risks of incident hospitalization or outpatient contact for heart failure were computed using cause-specific multivariable Cox regression with average treatment effect modeling. Of 26,835 individuals, 38.8% received a discharge diagnosis of myocardial infarction, 5.1% of unstable angina, and 56.1% of suspected myocardial infarction or chest pain. Within the initial 30 days, 1122/26,835 (4.2%) persons received a heart failure diagnosis, with an additional 707/25,085 (2.8%) diagnosed between days 31-365. Subjects with two normal hs-TnT values exhibited the lowest standardized absolute risk (0-30 days: 0.3%; 31-365 days: 0.4%), while those with persistently elevated concentrations demonstrated the highest risk (0-30 days: 6.6%; 31-365 days: 4.3%). Heart failure risk also exhibited a significant, positive association with peak hs-TnT concentration. CONCLUSIONS: In individuals presenting with suspected ACS, persistent hs-TnT elevation was associated with the highest risk of subsequent heart failure. A dose-response association was observed between peak hs-TnT concentrations and incident heart failure.
Authors: Philip Ahle Erichsen, Majid Afzal, Christina Byrne, Johanna Maria Christina Frary, Carlo Alberto Barcella, Muthiah Vaduganathan, Anna Meta Dyrvig Kristensen, Massar Omar, Monija Mrgan, Filip Søskov Davidovski, Rasmus Bo Hasselbalch, Kanyaw Kader, Maria Hang Xuan Pham, Marija Todorovic Markovic, Arman Qamar, Julia Frangeskos, Roxana Mihaela Popescu, Tarek Bekfani, Kaveh Hosseini, Tor Biering-Sørensen, Morten Schou, Lars Køber, Gunnar H. Gislason, Mikkel Porsborg Andersen, Christian Torp-Pedersen, Kristian H. Kragholm, Deepak L. Bhatt, Manan Pareek
Institutions: University of Copenhagen, Copenhagen University Hospital, Gentofte Hospital, Rigshospitalet, Brigham and Women's Hospital, Harvard University, Frederiksberg Hospital, Bispebjerg Hospital, Odense University Hospital, Hospital South West Jutland, Novo Nordisk Foundation, Zealand University Hospital, Endeavor Health, Northwell Health, Peconic Bay Medical Center, Carol Davila University of Medicine and Pharmacy, University Hospital Magdeburg, Herlev Hospital, Steno Diabetes Center Copenhagen, Aalborg University, Aalborg University Hospital, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,970
OpenAlex ID: W7204725357